Mindfulness-Based Stress Reduction for Residents: A Randomized Controlled Trial

Hanne Verweij, Hiske van Ravesteijn, Madelon L M van Hooff, Antoine L M Lagro-Janssen, Anne E M Speckens, Hanne Verweij, Hiske van Ravesteijn, Madelon L M van Hooff, Antoine L M Lagro-Janssen, Anne E M Speckens

Abstract

Background: Burnout is highly prevalent in residents. No randomized controlled trials have been conducted measuring the effects of Mindfulness-Based Stress Reduction (MBSR) on burnout in residents.

Objective: To determine the effectiveness of MBSR in reducing burnout in residents.

Design: A randomized controlled trial comparing MBSR with a waitlist control group.

Participants: Residents from all medical, surgical and primary care disciplines were eligible to participate. Participants were self-referred.

Intervention: The MBSR consisted of eight weekly 2.5-h sessions and one 6-h silent day.

Main measures: The primary outcome was the emotional exhaustion subscale of the Dutch version of the Maslach Burnout Inventory-Human Service Survey. Secondary outcomes included the depersonalization and reduced personal accomplishment subscales of burnout, worry, work-home interference, mindfulness skills, self-compassion, positive mental health, empathy and medical errors. Assessment took place at baseline and post-intervention approximately 3 months later.

Key results: Of the 148 residents participating, 138 (93%) completed the post-intervention assessment. No significant difference in emotional exhaustion was found between the two groups. However, the MBSR group reported significantly greater improvements than the control group in personal accomplishment (p = 0.028, d = 0.24), worry (p = 0.036, d = 0.23), mindfulness skills (p = 0.010, d = 0.33), self-compassion (p = 0.010, d = 0.35) and perspective-taking (empathy) (p = 0.025, d = 0.33). No effects were found for the other measures. Exploratory moderation analysis showed that the intervention outcome was moderated by baseline severity of emotional exhaustion; those with greater emotional exhaustion did seem to benefit.

Conclusions: The results of our primary outcome analysis did not support the effectiveness of MBSR for reducing emotional exhaustion in residents. However, residents with high baseline levels of emotional exhaustion did appear to benefit from MBSR. Furthermore, they demonstrated modest improvements in personal accomplishment, worry, mindfulness skills, self-compassion and perspective-taking. More research is needed to confirm these results.

Keywords: burnout; emotional exhaustion; mindfulness; randomized controlled trial; residents.

Conflict of interest statement

Prior Presentations

Preliminary results presented at the Spring Congress 2016 of the Dutch association for psychiatry, Maastricht, The Netherlands, April 1, 2016. Results were presented at the Wellbeing at Work Conference 2016 in Amsterdam, The Netherlands, May 30, and at the International Congress of Behavioral Medicine 2016, Melbourne, Australia, December 12, 2016.

Conflict of Interest

Dr. Speckens is clinical director of the Radboud University Medical Center–Centre for Mindfulness, which is embedded within the Department of Psychiatry. The Centre for Mindfulness has occasionally received fees from public (non-profit) organizations for lectures, workshops and/or educational presentations on mindfulness by Dr. Speckens. The other authors declare no competing interests.

Figures

Figure 1
Figure 1
CONSORT flow diagram. Flow of participants through a randomized controlled trial of Mindfulness-Based Stress Reduction, 2013–2016. MBSR = Mindfulness-Based Stress Reduction.
Figure 2
Figure 2
Plot of the for pre- and post-measurement emotional exhaustion scores with Loess curves for both conditions. MBSR = Mindfulness-Based Stress Reduction.

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